For each of the seven Charleston Consortium internship options, check the yes box if you would like for us to consider you for that option.

List your rotation and preceptor choices (in order of preference). (Remember, this form will be used only to evaluate your interests in specific areas within our program and in no way obligates you to use these rankings on Match Day or to include any of the Charleston Consortium tracks in your Match Day rankings.)

After your interview, please fax the completed form to the Internship Training Coordinator at (843) 792-3388 or e-mail it to the Coordinator at psychint@musc.edu

Note: You may complete the PDF form and print it with Adobe Reader, but you cannot save your completed form to be e-mailed unless you have a version of the Adobe Acrobat program. The completed form may also be e-mailed by scanning the print-out version, if you have access to a scanner.